JDog Junk Removal & Hauling: Start Up Insurance Questionnaire
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Company Profile
Requested Effective Date
MM
/
DD
/
YYYY
Name of Legal Entity
DBA
Mailing address (please include street, city, county, state & zip)
FEIN
Legal Entity
Soft opening date
MM
/
DD
/
YYYY
Grand opening date
MM
/
DD
/
YYYY
Principal contact name
Office phone number
Cell phone number
Email address
List the social security number of the primary business owner
List all members/managers/officers of your LLC and their respective % ownership:
Number of years of experience in the junk removal industry:
Please provide any professional, military, management, leadership skills that owner(s) have, and number of years of experience:
Desired effective date
MM
/
DD
/
YYYY
General Liability
General Liability is based off your annual estimated payroll or annual estimated gross sales. We will use the information that you entered above to estimate your premium based off the rate in your specific state. This is an upfront estimate only. Your quickbooks or financials will be reviewed at the end of the policy period by the insurance carrier, and your estimate will be “trued up” with your actually payroll or sales. The audit will then generate a return premium, or an additional premium owed based off the audited figures.
Will you as an owner be active in the business yourself?
Clear selection
What are your projected annual sales?
How many employees do you anticipate having in the first year of business?
Do not include yourself as an "employee". Please provide FT vs PT
Will you need a workers' compensation quote to start up?
Clear selection
Will you need a workers' compensation quote for the first year in business?
Clear selection
Workers' Compensation
Much like the General Liability policy, the Workers' Compensation policy will be rated based off of payroll and audited at the end of the policy term. Most start ups have been using a starting payroll of $30,000 per employee for quotation purposes.
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